Infant cardiopulmonary resuscitation : two thumb encircling technique vs two finger chest compression

Abstract

Overview of the topic: Cardiopulmonary resuscitation is a very common situation which is frequently encountered by emergency and paediatric nurses or midwives working at the Neonatal and Paediatric Intensive Care Unit (NPICU). This is usually encountered in infants who suffer from cardiac arrest as a result of different conditions such as sudden infant death syndrome (SIDS). Two different techniques which are most commonly used during infant cardiopulmonary resuscitation (ICPR) are the two-thumb technique and the two-finger technique. Thus, this dissertation will look into the effect of the two different techniques in terms of the compression depth achieved during ICPR. The research question: In infants suffering from Cardiac Arrest, is the vertical two thumb technique more effective than the two-finger chest compression in increasing the compression depth during cardiopulmonary resuscitation? PICO elements: The population (P) studied was infants suffering from cardiac arrest (CA). The intervention (I) was the vertical two thumb technique (TTT). The comparison (C) was the two-finger chest compression (TFT) and the outcome (O) was the compression depth (CD) achieved during cardiopulmonary resuscitation (CPR). Method: A thorough literature search was conducted mainly by making use of the University of Malta library databases together with Google Scholar. The key elements of the PICO framework were identified, and alternate words were applied in the search fields. Boolean operators and limiters were also applied. Inclusion and exclusion criteria were applied such as; all studies were published in the last ten years and were published in the English language. The Critical Appraisal Skills Programme (CASP) tool was utilized to critically appraise the key studies. Results: Six key studies were retrieved throughout the conduction of this systematic search. All six studies were randomized controlled trials (RCT). The findings of these RCTs suggested that the TTT is more effective than the TFT in terms of CD during ICPR. Even though all findings were found to be consistent, limitations were noticed throughout the method. Implications and Recommendations: More research is required to determine whether the TTT is the best choice of technique in all cases of ICPR. Preferably, studies should be based on real-life ICPR findings. Additionally, the infants’ age and physiological features should be recorded as this may affect the outcome of the two different techniques. Conclusion: It has transpired that when possible, the TTT should be used during ICPR to increase the CD and rate of survival as much as possible. More research is required to provide a definite answer, as not all healthcare workers who encounter ICPR frequently agree with the findings of these studies. Furthermore, future recommendations were also presented to improve local practice, education and management.